When the WHO Representative to Oman Dr Akjemal Magtymova was assigned her new duty station in Syria, traveling in the midst of the pandemic presented a formidable obstacle. All commercial flights were cancelled, and other options meant several days of travel, uncertainties and quarantines while crossing borders, and an increased chance of contracting COVID-19. “I was not content to start working on my new assignment from Oman. I am a person of duty,” she says of her desire to be physically present at her new post.
On the left: Dr Akjemal Magtymova signing the papers for her travel On the right: Dr Akjemal Magtymova on the plane traveling to Syria
With its fragile health, political, and economic systems, Syria presented her with new challenges. Nine years of war and deep political division have taken a toll on Syria’s health care system. As of December 2019, according to WHO Health Resources Availability Monitoring System (HeRAMS), only 50% of public hospitals run by Ministry of Health and Ministry of Higher Education reported fully functioning, 25% were partially functioning, and 25% were non-functioning.
Handing over, taking over
Before leaving Oman and handing over her functions as WHO Representative there, Dr Magtymova followed the tradition for a farewell meeting with the people she had worked with for nearly 3 years. During her farewell the Minister of Foreign Affairs asked her how she planned to get to Damascus. “By camel route,” she replied, cheerfully, determined one way or another to get to her new post. The Minister of Foreign Affairs exchanged a glance with his staff, she says, and shortly seats were secured on the only repatriation flight that was taking off the next day from Muscat to Beirut, to later reach her duty station of Damascus, by road.
She packed all her belongings in storage but insisted on bringing one thing: the Turkmen carpet her mother had made for her some 50 years ago. “It’s my identity and refuge. It reminds me of my roots and values. It grounds my mind in an otherwise very volatile environment,” she says.
When COVID-19 cases began spreading globally in February, Dr Magtymova made the difficult decision to cancel her long-planned flight from Oman to see her mother in her home country of Turkmenistan. Now she hopes this will be possible sometime later in 2020.
“To see my mom, I first have to be sure the pandemic is under control,” she says of her duty to stop the international spread of COVID-19. “Every day I call my mom she asks, ‘When are you coming?’ I answer ‘I will, as soon as the fight with COVID is over,’” she says knowing she cannot risk infecting her mom and being stuck with the uncertain flight restrictions.
For over 22 years, Dr. Magtymova has lived as a civil servant dedicating her time and energy to promoting global health and diplomacy for peace and sustainable development. Her work has placed her in her home country Turkmenistan, Lao PDR, India, Bangladesh, Maldives, DPR Korea, Yemen, Nepal, Oman, and now her 10th duty station of Syria. “My life is divided into many places and cultures, but my values are based on making choices for the collective good.”
Dr Akjemal Magtymova during the virtual interview
Dr Magtymova is a medical doctor and researcher in maternal medicine and human reproduction. She is also the mother of two children. Her mothering instincts combined with her medical and diplomacy studies make her uniquely qualified to care for the people of Syria. “Safety and wellbeing of my staff is my top priority and a prerequisite for our top performance at times of need,” she says. Magtymova is seeking out a separate room in their hotel to function as a kitchen in case they are forced into quarantine. “I’m trying to establish a home for my staff in the hotel – home to all UN international staff residing in Damascus.” Two texts messages from close friends – WHO colleagues - had woken her that morning announcing the death of loved ones due to COVID-19. “I share personal experiences and testimonies with my colleagues to encourage them to remain healthy and determined.”
Need to raise awareness and lead by example
When Dr. Magtymova arrived in Syria, she was struck by how little people of all social and educational backgrounds recognized the seriousness of COVID-19. There was little compliance to social distancing or other measures. She started to invest efforts, immediately upon her arrival, to work with country representatives of UN agencies to follow the WHO recommended measures for prevention of COVID-19. She believes all UN staff in Syria would be example for compliance with these recommendations.
"Overall, there is little recognition of the seriousness of COVID-19 in this country it seems. The risk communication messages sent via media have not reached people in such a way that they would adopt the recommended behaviours. After nine years of war, the sentiment here is that Syrians are strong and may be immune to disease.”
This sentiment persists despite the effort made to educate Syrians on COVID-19. WHO and UNICEF have collaborated extensively to enhance risk communications and community engagement by conducting awareness training, providing more than 50 interim guidelines and disseminating more than 620,000 information education and communication materials. Some 12 million people have been reached by television and radio awareness campaigns and printed information materials. Over six million people were reached through social media – platforms that partners continue to actively utilize for awareness raising.
However, compared to war and starvation (9.3 million people in Syria are now considered food insecure, an increase of 1.4 million in the past six months), the pandemic seems benign to many Syrians. This wrong impression, Dr Magtymova surmises, may be due to the few number of COVID-19 cases detected and announced so far by the Ministry of Health. As of the 19th of June, there were 178 confirmed cases (rural Damascus being the highest affected) and seven deaths.
These small numbers are partly due to Syria being a country less open to international travelers, but mainly a result of its laboratory testing and local surveillance capacities. The low incidence rate of COVID-19 in Syria (0.9/100 000) may be due to the low testing rate of 33 per 100 000. For WHO to provide epidemiological evidence for the WHO generated predictions to support MOH risk management messages, Dr Magtymova says, “We need more data, and our first step is to strengthen testing capacity.”
While she argues that command and control work better in emergency response situations (like a global pandemic), she acknowledges the delicate balance between protecting the economy and introducing public health measures. “It becomes an ethical dilemma.” she shares. The lesson to be learned during the pandemic, she asserts, is the importance of government and global community policies to ensure universal health coverage, adequate funding, and equal allocations for preparation and response to public health emergencies.
Upon arrival in Damascus she realized that both leaders in the UN and blue-collar Syrians were experiencing difficult times in the wake of the pandemic. They grieved the loss of routine and purpose. They also wanted to help.
We at WHO are surgeons – here to stop the bleeding.
While we (often under-resourced) are focused on urgent “surgical” intervention, our colleagues from the UN family are eagerly asking, ‘How can we help you?’” Akjemal understands the best chance to fight COVID-19 is to act in partnership.
Dr Magtymova, as the WHO Representative, has to identify and prioritize needs, set standards, assign tasks, and coordinate support. Many UN agencies are enthusiastic to be a part of the COVID-19 response in Syria. For example, WHO provides technical leadership to UNICEF working on risk communication and community engagement in Syria to help slow the rate of transmission. Since over half of positive COVID-19 cases are among Syrians returning home from other countries, the UN Refugee Agency (UNHCR) plays an important role by supporting the authorities neighboring countries to set up quarantine facilities following WHO standards and WFP helps by providing food distribution.
Dr Magtymova meets with humanitarian aid donors to understand their interests and what restrictions they face. Many suppliers associate Syria with sanctions, she says, so they are less likely to invest unless they understand the situation. She listens to their different perspectives in a highly politically complex environment while remaining neutral and independent.
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Zouheri Houbbi public health center: Ghaith Kokash, Mother’s name: Samah, 14 days old (born on 4/6/2020) was vaccinated against tuberculosis, Hepatitis B and Oral poliovirus.
“Especially in the context of Syria, where the state is fragile, systems are disrupted, the economy is worsening, and people’s vulnerabilities continue growing with the impact of COVID-19, coordinated support from all is paramount to defeat the public health emergency and save lives and livelihoods,” says Magtymova.
WHO has provided the Ministry of Health and health sector partners (UN, Syrian Red Crescent and national institutions as well as local NGOs) with essential supplies that are in high demand. To date, almost 1 million pieces of personal protective equipment for health care workers has been delivered, along with intensive care beds, and 27 ventilators.
Professional and personal life – it is not either or but both
In addition to her demanding work as a civil servant, Dr Magtymova works to balance her roles as wife, daughter, and mother. “For women in senior positions in the UN it is a challenge to strike a balance between family, marriage, and work”, she says. Her children, who live in Toronto, are 25 and 29 years old. And for over 14 years, she and her husband, a former military officer and former UN civil servant, have had to live apart.
She thinks of her son and daughter and of her husband who are far away caught in different continents and who have always been her anchor, support and inspiration. “It’s time I feel to be together with the family because I don’t know how long…,” she says. Her voice trails off as emotion overcomes her. “Despite being apart, my husband and my family have been always by my side, providing support and care to help me to stand by my choice of serving others and remaining in active duty. Humanity needs the public health workforce more than ever,” she continues, “Look at my short grey hair,” she smiles, “I don’t mind. Keeping it like that is one way to optimize my time and stay in action. I am only one among many staff on the ground and I know what it is to accomplish a global mission. Now, my Organization is on the frontline fighting COVID-19. I am part of that and proud to be able to help the country and the region”.
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Redefining global care: Duty, service and choices made in the time of COVID-19 - World Health Organization
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